Senate Proceeding on Jun 19th, 2009 :: 3:53:55 to 4:12:30
Total video length: 6 hours 11 minutes Stream Tools: Stream Overview | Edit Time

Note: MetaVid video transcripts may contain inaccuracies, help us build a more perfect archive

Views:85 Duration: 0:18:35 Discussion

Previous speech:

Next speech:

3:53:47 to 3:54:07( Edit History Discussion )

Pat Roberts: consenthat the quorum call be dispensed with. the presiding officer: wit objection. mr. roberts: i ask unanimous we're in morning business for approximately 15 minutes. the presiding officer: without objection. mr. roberts: mr. president, and to all present in terms of staff, i apologize. this is friday. here we are a,

3:53:55 to 4:12:30( Edit History Discussion )
Speech By: Pat Roberts

3:54:08 to 3:54:28( Edit History Discussion )

Pat Roberts: i apologize to the doorkeepers. i apologize to the elevator operators. i don't want to keep you here for a long time and so i'll quit apologizing. happening in regards to health care. the distinguished senator from rhode island indicated the need to move everybody agrees to that. but the pace of it and what's

3:54:29 to 3:54:49( Edit History Discussion )

Pat Roberts: going on is of real concern. so i do have some remarks to make, and i'll try to make this as quickly as possie and succinct as possible so that everybody here can go about their business. i see smiles from the pages in regards if i can just hurry up and get through this comment -- or my comments. mr. president, yesterday in the

3:54:50 to 3:55:10( Edit History Discussion )

Pat Roberts: "help" committee's markup of the kennedy-dodd health care reform bill, we had a very good discussion about the proper use and the objectives of something called comparative effectiveness research. now, i know that's getting in the weeds in regards to health care language and health care acronyms.

3:55:11 to 3:55:31( Edit History Discussion )

Pat Roberts: it's called c.e.r. -- rember that term, c.e.r., it's going to be around for a long time because it's become quite controversial in regards to our health care discussion and what eventually passes. c.e.r. is research that compares the relative outcomes of two medical treatments for the same condition to determine which one

3:55:32 to 3:55:52( Edit History Discussion )

Pat Roberts: is better. that's a good thing. it's a good thing to disseminate and to inform doctors, and everybody in the health care delivery system -- nurses, health care providers, pharmacists, et cetera, et cetera -- it's a good thing. but the first problem with

3:55:53 to 3:56:13( Edit History Discussion )

Pat Roberts: c.e.r. is that not every patient is the same. what is better for one patient may not be better or could actually be worse for another. for this reason, doctors and patients must be able to deviate from the results of something call or a master evaluation that

3:56:14 to 3:56:34( Edit History Discussion )

Pat Roberts: could come out of washington from an outfit called c.m.s. under and human services. the patients must be able to deviate from the results of this and make treatment decisions on a case-by-case individualized basis. that's what we want want in

3:56:35 to 3:56:55( Edit History Discussion )

Pat Roberts: terms of our -- that's what we all want in terms of our treatment with our doctors. now, it is other major problem, i would submit, is t has been used by other governments, such as the united kingdom, to base treatment decisions not just on relative effectiveness but on relative cost. and there's the rub. if c.e.r. is going to inform

3:56:56 to 3:57:17( Edit History Discussion )

Pat Roberts: doctors and everybody in the medical community that this kind of treatment or this kind of best practices, this is the arena in which you should operate or pasture you should operate in, that's okay. but if it's used in regards control costs as opposed to care, then we've got a problem.

3:57:18 to 3:57:39( Edit History Discussion )

Pat Roberts: by giving priority to the relative costs of the treatments being compared, the government can deny access to health care based on what i would call pseudo science under the guise of which brings me back to yesterday's discussion on c.e.r. in the "help" committee markup.

3:57:40 to 3:58:00( Edit History Discussion )

Pat Roberts: the kennedy-dodd bill includes a section that establishes a new center for health outcomes, research and evaluation. and this outfit is to conduct and support comparative effectiveness research. section 219-h-1- now, if that consistent getting into the weeds, i don't know what is -- but that section includes the

3:58:01 to 3:58:21( Edit History Discussion )

Pat Roberts: following language relating to the practical effect of c.e.r., or comparativeffectiveness research. that would, aga, be conducted by the center. and the center reports and recommendations shall not be construed as mandates for payment, coverage or treatment. so that language was in there to get at this proble

3:58:22 to 3:58:43( Edit History Discussion )

Pat Roberts: us who worry that c.e.r. will be used by c.m.s. -- that's another acronym. that's the outfit that runs medicaid and medicare in terms of services. these are the people who count th beans. these are the people that want to turn the red beans into bl beans. these are the people that are into cost containment. these are the people that many times drive hospital

3:58:44 to 3:59:04( Edit History Discussion )

Pat Roberts: administrators and board members in small hospitals crazy. but at any rate, to worry abou about -- or to take away the worry, that language was put in there, senate reports and recommendations shall not be construed as mandates for payment coverage or treatment. and they thought that was enough to protect us in regards to c.e.r. dictating

3:59:05 to 3:59:26( Edit History Discussion )

Pat Roberts: and stepping inbetween you and your dock tear. -- you and your doctor. let's go back to those words: shall not be construed as man daissmentmandates. what does that mean? the word "mandate" means to force and combine. this should not be interpreted as to forcinr.s. railroad the veterans administratioor

3:59:27 to 3:59:47( Edit History Discussion )

Pat Roberts: department to restrict payments to doctors based on its results. senator mikulski and and i dr. coburn as well had a very lively discussn about the intent of this language. senator mikulski said that the intent of the language was to keep the right to make treatme decisions with the doctor and th government. i certainly agree with that. and senator mikulski has worked

3:59:48 to 4:00:08( Edit History Discussion )

Pat Roberts: long and hard on this bill and i respect her for that. she is a good expleeg a good friend -- good colleague and a good friend, and i agree with this intent. but as i pointed out to the senator, the language in the kennedy-dodd bill does not accomplish our common intent. saying that the government is not mandated or forced to use the results of this comparative effectiveness research to make

4:00:09 to 4:00:29( Edit History Discussion )

Pat Roberts: payment decisions, whether you're paid or not in regards to medicare, or, for that matter, medicaid, is not the same thing as prohibiting or preventing c.m.s. from doing so. in order to vigorously protect the right of patients and doctors to make treatment decisions against the danger the government will interfere i believe the bill

4:00:30 to 4:00:50( Edit History Discussion )

Pat Roberts: must prohibit the government from using the results of c.e. exprvment making payment coverage or treatment decisions. sorr you can't have that treatment, you have to have this treatment because it is a best-medicine practice regardless of the fact that you and treatment and the doctor thinks that's the best treatment for

4:00:51 to 4:01:12( Edit History Discussion )

Pat Roberts: you. i offer new language and the new language would have placed a clear bright line firewall betwee comparative research which is essential to advancing medical science. it's a good thing. and the use of its results to restrict your doctor if using

4:01:13 to 4:01:34( Edit History Discussion )

Pat Roberts: his or her best judgment when treating my language which i further modified at suggestion of accept mikulski read "senator roars and recommendations are prohibited from being used by a government entity for payment or treatment decisions." and senator mikulski agreed to consider the suggestion last night and i appreciate that. but, today, when the help

4:01:35 to 4:01:55( Edit History Discussion )

Pat Roberts: committee reconvened our markup, senator mikulski and the majority refused to accept my language and o language that would basically put us back to square one doing nothing to protecting patients and doctors from government agency interfering in their treatment decisions. when i asked why my language was

4:01:56 to 4:02:17( Edit History Discussion )

Pat Roberts: unacceptable, which i thought was acceptable for much when we left yesterday i was told that the decision to say my language was not acceptable was based on concerns by -- quote -- "washington policy experts." and i said, who's that? which "washington policy expert"

4:02:18 to 4:02:39( Edit History Discussion )

Pat Roberts: said my language was not acceptable. and when pressed on which "policy experts" we learned that the directive had come straight down if the white house. now, why would the white house be so concerned about prohibiting federal government from using comparative effective research to restrict payments to

4:02:40 to 4:03:00( Edit History Discussion )

Pat Roberts: doctors or to direct doctors to follow specific treatment orders? why would the white house do this on this a proposal that really affects what the government is going to do or tell doctors and patients what they can expect.

4:03:01 to 4:03:25( Edit History Discussion )

Pat Roberts: it is clear from statements made by this administration that they see c.e.r. as the golden reign for cost containment. the president said when asked how on earth will you pay for the health care bill he said we're going to cut medicare patients. how are you if you have a comparative effective research golden reign that.

4:03:26 to 4:03:47( Edit History Discussion )

Pat Roberts: cans from c.m.s. or national institutes of health you can see the research says you should follow these practices, not those practices and those practices, or these practices would certainly cost less. and i don't thinkhat's a go thing. and from the o.m.b. director, peter orszag to n.i.h. director

4:03:48 to 4:04:08( Edit History Discussion )

Pat Roberts: to national economic council director larry summers and indications from our new secretary of health and human services, kathleen sebelius, all have pointed to the huge potential of c.e.r. to be used to contain costs -- not to recommend procedures best for

4:04:09 to 4:04:30( Edit History Discussion )

Pat Roberts: the patient, as determined by the patient and doctor but by c.e.r. to control that is why the white house does not want to prohibit a government agency if using the results to deny you and your doctor the right to choose the treatment that is best for you.

4:04:31 to 4:04:51( Edit History Discussion )

Pat Roberts: now, after all that was said and done, and a lot was said and not much done, i got quite a lecture this morning in regard to my use of the word "rationing" to describe what this could lead to. this lecture was preferred to as a "scare tactic."

4:04:52 to 4:05:12( Edit History Discussion )

Pat Roberts: and they indicated that i was using the word scare tactic to scare people to say that we don't want health care reform. and i find that rather condescending and demeaning. and it certainly is not accurate. you tell me when medicare fuses

4:05:13 to 4:05:33( Edit History Discussion )

Pat Roberts: to pay your docto if he or she decides you need a particular course of treatment that definite eights from the government standard -- deviates from the government standard what do you call snit i call it rationing and it is happening right now this this country. we may not have explicit

4:05:34 to 4:05:55( Edit History Discussion )

Pat Roberts: rationing like in the united kingdom where the government refuses to give elderly people drugs to treat their macular degeneration until they have already gone blind in i am not making that up -- or refuses kidney cancer drugs for temple natural patients because it's not worth the money to extend their life by six months -- that's really rationing.

4:05:56 to 4:06:16( Edit History Discussion )

Pat Roberts: but we do have de facto rationg because medicare and medicaid refuse to pay doctors anything close to what their costs are. by the way, same thing for pharmacists and the same thing for home health care and the same thing for all the providers of the provider health care. so those doctors can't afford to take medicare and medicaid

4:06:17 to 4:06:37( Edit History Discussion )

Pat Roberts: patients and they make the decisions and those individuals do not have access to care and that's rationing. i'm talking about a doctor who makes a decision, you know i'm only getting paid 70 cent on the dollar in terms cost on medicare patient and i have to hire extra people to keep up with all the paperwork and regulations.

4:06:38 to 4:06:59( Edit History Discussion )

Pat Roberts: those people don't exist in the rural health care delivery system and we have them, find them, and it is a lot easier if i drop the medicare program. now, that comes as a sudden jolt and a sudden decision that is just not fair in regard to the patients that were being treated

4:07:00 to 4:07:22( Edit History Discussion )

Pat Roberts: by that doctor in terms of medicare and that's what we call rationing right now in regard to the united states of america. we know that the administration wants to use c.e.r. to contain cost. we know c.m.s. has a history of denying full payment based on cost. i'm not going to take the time on the senate floor right now to

4:07:23 to 4:07:43( Edit History Discussion )

Pat Roberts: go into all of the problem c.m.s. has posed for the health again, these are the folks that have a difficult task. they're trying to change the red beans and the black beans so health care doesn't cost so much but in terms of their decision here in washington in regard to what care is going to be paid for and what isn't, they

4:07:44 to 4:08:04( Edit History Discussion )

Pat Roberts: absolute nightmare to every hospital administrator, every hospital board member in the 350-some hospitals i have in kansas, in the 83 critical access hospitals i have in kansas. weon't have a very good relationship with what we have is a meaningful

4:08:05 to 4:08:25( Edit History Discussion )

Pat Roberts: dialogue when yet another regulation comes down the pike to contain costs. most of which the doctors have never heard of not to mention everybody else in the health care delivery system. so i can go into quite a rant as you can expect from my comments in regard to c.m.s. and what they do and what they don't do.

4:08:26 to 4:08:47( Edit History Discussion )

Pat Roberts: why are the democrats resisting my language to protect patients and their doctors? you and your doctor and your right to make the right treatment decision for you? why are they trying to muzzle my warnings this could lead to the rationing of health care? it boils down to the fact they don'tant the american people

4:08:48 to 4:09:08( Edit History Discussion )

Pat Roberts: to know what their true plans could actually be. that's why they're shoving t massive health care reform bill through congress at warp speed having markups before we have complete language or cost st.s. now, we just heard from the distinguished senator from rhode island abo the need for health

4:09:09 to 4:09:29( Edit History Discussion )

Pat Roberts: care reform and the fact he was complaing over 100 amendments in the help committee. my goness, almost every major bill i have been associated with we have literally, hundreds of ams and many fall by the wayside, many are withdrawn. we dealt with 17 or 18 of them as of today and senator and senator dodd did a good job along with our ran

4:09:30 to 4:09:50( Edit History Discussion )

Pat Roberts: senator enzi, from wyoming. but it would be helpful if we're going to manufacture forward with health care reform if we had the bill. we don't have the bill in the help committee but one of the bill and then we have a congressional budget office score on one-sixth of the bill and that's $1 trillion and boy

4:09:51 to 4:10:11( Edit History Discussion )

Pat Roberts: did that sho $1 trillion forne-sixth of the bill? what is the wle bill going to cost? thatol estimate is some the neighborhoods of $4 trillion. how will you pay in the finance committee, $4 trillion for health care reform and take it from the health care delivery system. i don't th but we don't know because we

4:10:12 to 4:10:32( Edit History Discussion )

Pat Roberts: haven't seep the we're being asked to go on a deadline schedule to amendments -- things like c.e.r. that worry people in regard to possible rationing by a date certain, or a time certain -- and we haven't even seen the bill we're amending. i've never been through a

4:10:33 to 4:10:53( Edit History Discussion )

Pat Roberts: situation like that not to mention the specific cost estimates by c.b.o. this is in the right. that is request chairman baucus in the finance committee had at least the good sense to postpone the markup of his bill until we could work this out. and doesn't necessarily mean

4:10:54 to 4:11:16( Edit History Discussion )

Pat Roberts: everne is opposed to health care reform it means we ought to get it right and we at least ought to have a bill to read to know what we're dealing with. i think it's because they know if americans knew what they were doing they would never stand for it. i think we need to get this to the public and the public hopefully can fully understand. i am not going to allow this. personally, i'm going to

4:11:17 to 4:11:37( Edit History Discussion )

Pat Roberts: continue to shout it from the rooftops, beware of what lurks under the banner of "reform," and to tell every doctor and hospital add minute streart, every -- administrator, every hospital board member and everyone who has anything to do with the health care dleferry system, watch out in regard to c.e.c. it could put you out of business.

4:11:38 to 4:12:00( Edit History Discussion )

Pat Roberts: it could put you out of business. we have examples of c.m.s. doing exactly that. do back up one difficult and realize, mr. president, that the government has tken over your health care the same way they have taken over the banks and auto industry. don't let them ration your health care. rationing is not what we need.

4:12:01 to 4:12:23( Edit History Discussion )

Pat Roberts: it would be terribly counterproductive. i hope that we can do a better job in the future. i yiel and i suggest the absence of a quorum. the presiding officer: the clerk will call the roll.